Another review of the H1N1 scene

Today, the date toll for H1N1 rises to 32. Many people are asking me whether the disease is becoming more serious since the mortality rate seems to have gone up.

At the first look, yes, the apparent rate has gone up, since there are now 32 deaths and thousand plus CONFIRMED cases. But the actual rate is much lower than that.

Many of the flu cases now are H1N1 and majority are very mild, so they do not get picked up, since government is only doing the confirmatory tests on more serious cases like those down with pneumonia, and those in the high risks groups.  So the actual cases of H1N1 is much much higher than the thousand over cases reported.

This is unlike initially during the containment phase. During that time, most cases coming back from overseas with H1N1 were detected and quarantined , whether mild or serious.  And most contacts were traced and those contacts with H1N1 were also detected. SO the pick up rate was much higher. However, not all cases were detected, otherwise the disease would not have spread, since many of those coming back with H1N1 virus from overseas had no symptoms at all when they went throught the check point at the airports, but only developed symptoms after one or 2 days… Many did not get picked up. Still, the pick up rate was much higher than now, when most of the flu cases are actually H1N2 but did not get tested because they are not serious enough.. The government facilities cannot simply coped with the huge numbers of patients turning up in governemnt clinics.

So nobody knows how many actual H1N1 cases were there. But based on what was told to me by a government doctor, a sampling test among flu patients detected 5 H1N1 out of 6 cases with flu. That is why SIngapore has said that if you are having symptoms of flu like cough and runnign nose now, chances are you are having the H1N1 flu.

My estimate based on the number of sick people in schools , classes and so on, the actual number may have reached hundred of thousands.

I have predicted, during the initial outbreak of H1N1 overseas, that although this flu is mild and like seasonal flu, the ABSOLUTE number of people dying will be high since this flu spreads very easily.

Let us presume that the mortality rate is 0.4% (the actual rate is much lower since there are many milder cases not detected, but let us assume it to be 0.4%) .  Which means that for every 100 million actual H1N1 cases, there will be 400,000 deaths. 

Most of those who died, based on the experience so far, are those in the high risk group: those with co-morbid diesases such as heart failure, kidney failure, cancers , those who are pregnant, those very old and very young, those with chronic lung problems such as asthma, HIV cases, those on immunosupressive drugs like transplant patients. Another group is the obese people. Obesity is defined as having a BMI of more than 30. From the experience so far, obese people seem to be at high risk of developing pneumonia, and the postulation is that obese people tend to hypoventilate, meaning their beathing is slower and more shallow.

So while most of us will get a mild flu if ever we get H1N1, the onus is on us not to spread it to those in the high risk groups. If you are down with flu, stay at home and isolate yourself from those in the high risk groups..If you need to go out, wear a mask and wear it properly. I have seen so many people wearing masks covering their mouths only without covering their nostrils, which defeat the purpose of wearing mask.

All of us need to practise good personal hygiene. Wash our hands properly before touching ourselves, or our loved ones, or before eating. Wash our hands after touching handrails of escalators, stairs, supermarket trolley handles; for that matter, wash our hands after we touch any surfaces in public places before touching ourselves or our loved ones.

We need to have good sleep (see my earlier posts), adequate exercise, balanced diet and plenty of fluid intake to boost up our immune system.

The government  should have done more to educate Malaysians on proper etiquette when they are having flu, even mild ones. You may have a mild flu when you get H1N1, but the same virus can be DEADLY if spread to someone who is in the high risk groups. Look at it this way:  For everyone who died, there must be someone who have inadvertently killed him by spreading the virus to him.

I have seen people coughing and sneezing directly into the faces of someone else, some their loved ones. They have no qualm to pass on the virus. So we need to educate Malaysians not to do that. If they need to cough or sneeze, cover their mouths and nostrils with tissues or at least with their hands , and dispose off the tissue properly and wash their hands immediately. SOme Malaysians have this couldn’t care less type of attitude: So-what-if-I-spread-to-you, you-die-and-not-I-die type of attitude .. Luckily not all malaysians are like that.

So we all need to do our part. The death toll is going to rise, but we need not panic. FOr most of us it will be a mild flu, but do be vigilant and practise proper etiquette and good personal hygiene  so as not to spread the virus around. I stress again:  It may be mild to you, but it can be DEADLy for those in the high risk groups, and that can include your own loved ones.

 

Read my earlier article on H1N1:

Do not be unduly worried

Revisiting the H1N1 scene